Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | R130529 | MD |
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | R130529 | MD |
NPI | 1144588294 |
---|---|
Provider Name | Ms. Kerri L Bouchard |
First Address | Rosemont, IL 60018-4989 |
Second Address | Columbia, MD 21045-3263 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2012 |
Last Update Date | 26/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
067423100 | (05) | MD |
S062-0536 | CAREFIRST BC/BS (01) | MD |